Eboney Jackson, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

32651 Issued in TX

Practice address

6711 S New Braunfels Ave
Suite 100
San Antonio, TX 78223-3005

Phone

(210) 532-8811

Fax

(210) 531-8172

NPI assigned

Jan 31, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gulf Bend Mental Health Mental Retardation Center

  • Professional Counselor
  • Victoria, TX
  • NPI 1467434399
  Medicare reassignment NPD
• Health and Human Services Commission

  • Clinical Neuropsychologist
  • Harlingen, TX
  • NPI 1356414692
  Medicare reassignment NPD
• Russel Thompson, PHD & Associates PC

  • Psychologist
  • San Antonio, TX
  • NPI 1932431350
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1497093116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6502 NURSERY DR. STE. 100",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "77904",
            "telephone_number": "361-575-0611",
            "fax_number": "361-579-6913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6711 S NEW BRAUNFELS AVE",
            "address_2": "SUITE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782233005",
            "telephone_number": "210-532-8811",
            "fax_number": "210-531-8172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EBONEY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-31",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "TX",
            "license": "32651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crae Jackson
• Daija Adeine Jackson
• Danielle Nicole Jackson
• Delores Jackson, LCSW
• E Penn Jackson Jr., DDS
• Ebony M Jackson, LVN
• Folashade Agnes Jackson
• Gregory M. Jackson II, FNP-C
• Gregory Mann Jackson, M.D.
• Hannah Joy Jackson, DO

• Counseling Psychologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Counseling Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.